Current concepts in sport concussion management: A multifaceted approach

Sport-related concussion is a common neurological injury that occurs in all levels of athletic participation. Concussions may actually go undiagnosed, as they do not always display outward signs and athletes may fail to report symptoms of concussion, either because they do not know the symptoms, or for fear of removal from play. Inappropriate management of concussion can lead to increased risk of subsequent injury. This article outlines various aspects of sport-related concussion management, including preparation/planning, education, evaluation, management, return to play decisions, and long term effects of concussion. Preparation and education are the first steps that must be taken to minimize the potentially negative consequences of concussion. If a concussion is suspected, it must be stressed that the evaluation should include a multifaceted approach, with a physical examination and assessment of signs and symptoms, neurocognition and balance. The management of concussion should include both physical and cognitive rest and factors such as transportation, sleep, work, and academics should be taken into consideration. Return to play following concussion should follow a graduated return to play protocol, with careful monitoring of symptoms. Sports medicine clinicians should stay up to date with information regarding concussion management and take a conservative approach, because there are recent reports of various cumulative effects of multiple concussions.